Is Gluten Making You Miserable?

Depressed? Achy? Tired? Overweight? Your morning toast could be to blame. The cardiologist who developed the South Beach Diet offers an exclusive look at his new book, which reveals the hidden danger in grains.

Fifteen years ago, I created the South Beach Diet to help my cardiac and diabetes patients lose weight and improve their blood chemistries in order to stop the progression of atherosclerosis and avoid having a heart attack or stroke.

I never expected to write a best-selling diet book, but I was inadvertently pushed into the role when I noticed that the standard, so-called heart-healthy, low-fat diet popular at that time was actually making my patients fatter and sicker. Once I switched my patients to our strategy involving good fats, good carbs, lean protein, and high fiber, I was amazed at how quickly their health improved and their waistlines shrank.

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To make it easy for patients to incorporate the diet into their busy lives, I developed a simple, three-phase approach that I still recommend today. During Phase 1 of the South Beach Diet, all grains (including whole grains) and other starches, sugars (including fruits and fruit juices), and alcohol are excluded for 2 weeks. This is the rapid but healthy weight loss phase designed to eliminate cravings for sweet, sugary foods and refined starches. As a result, you gain control over what you eat and get quick results—typically, a loss of 8 to 10 pounds—which is encouraging and motivating.

You would think that people following the "no grains, no fruits" dictum for 2 weeks would be eager to move on to Phase 2. But some weren't. In fact, many South Beach dieters wanted to stay on the grain-free Phase 1 forever. I was perplexed. At first I attributed their euphoria to their rapid weight loss and the stabilization of their blood sugar, freeing them from the cravings that had sabotaged their diet attempts before. But as I saw patients with lifelong arthritis and psoriasis go into remission, I began to wonder if there might be something more to Phase 1 than meets the eye. What I would eventually and unexpectedly discover is that it had to do with gluten.

The Gluten Connection

What is gluten? Along with being the subject of the latest diet craze, gluten is the major protein found in some grains, including all forms of wheat (bulgur, durum, semolina, spelt, and farro), as well as barley and rye and a wheat-rye cross called triticale. Gluten is also a common additive found in all kinds of products, including prepared foods, cosmetics, and even medicines.

For the 1% of the population who have a condition called celiac disease, gluten can be a matter of life or death. They are so sensitive to gluten that even the smallest amount can make them very sick. Their symptoms: chronic fatigue and skin rashes to severe abdominal cramping and osteoporosis. They are also at higher risk of some cancers.

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Yet I have found that countless others should avoid or at least limit their intake of foods containing gluten, because they are to varying degrees gluten sensitive. The vast majority haven't the faintest idea that gluten is at the root of many of their health problems. When they eat foods with gluten, it triggers unpleasant symptoms—stomach pain, diarrhea, heartburn, body aches, headache, skin rashes, fatigue, brain fog, and depression—and sometimes leads to or exacerbates chronic illnesses such as fibromyalgia.

While specific diagnostic tests can confirm celiac disease, that's not the case for gluten sensitivity. If you have symptoms but tested negative for celiac disease, you may be gluten sensitive. The only way you know whether gluten is a problem for you—and to what degree—is by observing whether sharply reducing or eliminating gluten from your diet relieves your symptoms.

One case I observed was so dramatic that it led directly to my current obsession with gluten and was certainly one of the reasons I developed and wrote The South Beach Diet Gluten Solution. Jane, one of our South Beach Diet editors, had long suffered from a severe case of psoriasis, an autoimmune disorder. Her dermatologist recommended that she consider starting Enbrel, a drug that dampens the immune response and carries a risk of serious side effects. While mulling over this decision, Jane began Phase 1 of the South Beach Diet. To her surprise, her psoriasis significantly improved, and she didn't need to take Enbrel.

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Jane's experience was my aha moment: It became clear to me that Phase 1 of the South Beach Diet had reversed her psoriasis (and she's been nearly psoriasis free for 5 years!). She tested negative for celiac.

We saw something similar happening in many of our South Beach Phase 1 dieters. They continued to report significant weight loss, but they also told us they had more energy, better sleep, and improved concentration, and the heartburn, headaches, rashes, and other ailments that plagued them went away—as long as they stayed on Phase 1. When they reintroduced gluten—containing grains on Phase 2, their symptoms returned, suggesting these people had a problem related to gluten.

See What Works for You

Phase 1 of the original South Beach Diet eliminates all grains but not all forms of gluten (such as soy sauce, in which wheat is often the major ingredient), so unless you have celiac disease, you don't have to eliminate all gluten products to feel great. Some people have symptoms with just one serving of whole wheat bread or cereal, while others feel fine until they've had a few more. You have to determine your tipping point by trial and error.

During Gluten Solution Phase 1, don't eat anything made with wheat, barley, or rye, and try to avoid any product that contains gluten. In fact, you won't eat any grains at all—or fruits, for that matter—because we want to get the blood sugar swings that cause your cravings under control.

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By the end of the first 2 weeks, you should have lost 8 to 10 pounds, your cravings should have subsided, and your symptoms of gluten sensitivity should have diminished. If not, stay on GS Phase 1 for 1 to 2 more weeks. Minor symptoms such as bloating, reflux, and fatigue can disappear in a few days to a couple of weeks, while other symptoms, such as arthritic complaints, take longer.

If you feel great after 2 weeks and move on to GS Phase 2, begin to reintroduce gluten-free starches, as well as fruits, gradually over the next 14 days, working up to three starches and three fruits a day. Stay away from gluten, because research studies show that it takes at least 4 weeks off gluten before reintroducing it to discover a true sensitivity.

After 30 days, if your symptoms are relieved (but you need to lose more weight), you can begin to reintroduce some gluten gradually, one serving at a time. Pay attention to how you feel after adding back gluten-containing foods. Some people have intestinal trouble with even one serving. Experiment to find your limit.

Take the Quiz: Could It Be Gluten?

Check off any of these common signs of gluten sensitivity that you experience. Note: This is just a small sampling of symptoms. If you've ever been told you have an autoimmune disorder, such as thyroiditis, type 1 diabetes, rheumatoid arthritis, psoriasis, fibromyalgia, or lupus, consider the possibility that gluten could be causing it or making it worse.

Do you frequently suffer from constipation or diarrhea? Do you often have abdominal pain or stomach cramps? Do you often suffer from headaches? Do you often feel bloated after eating even a small amount of food? Do you typically feel fatigued even after getting enough sleep? Do you have difficulty keeping your mental focus? Do you have excess mucus, postnasal drip, rhinitis, or chronic sinus problems? Do you suffer from skin rashes? Do you wake up with stiff joints? Do you have depression?

If you checked off even one of these symptoms, you could be one of the millions of people with undiagnosed gluten sensitivity.

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